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Special Alert December 2025 - Medicaid Benefit: Complex Rehab Technology (CRT) Repair at Providence Health Plan
Providence Health Plan·OR · Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab) +1 more·Provider News
Effective date
Jan 1, 2026
We identified it
Dec 1, 2025
Summary
Effective January 1, 2026, Providence Health Plan (Oregon Medicaid) eliminates prior authorization requirements for Complex Rehab Technology (CRT) repairs under Senate Bill 549. Providers must bill all CRT repair claims using modifier RB to ensure proper processing and avoid denials. Prior authorization is still required only for CRT replacements, new equipment/upgrades, or items that don't meet the SB 549 CRT definition.
Action Required
By December 31, 2025: Billing team must implement the following changes for all Providence Health Plan Oregon Medicaid claims: (1) Update billing software to automatically append modifier RB to all CRT repair claims; (2) Configure system to bypass prior authorization requirements when modifier RB is present on CRT repair services; (3) Create or update internal guidance documents distinguishing between repairs (no PA required) vs. replacements/new equipment (PA still required); (4) Train billing staff and providers on proper use of modifier RB and documentation requirements. Effective January 1, 2026: All CRT repair claims must be billed with modifier RB. Claims submitted without modifier RB may be denied or incorrectly routed to prior authorization. Maintain documentation supporting all repair work (issue description, components repaired, labor/parts justification, confirmation of restored function) in patient records but do not submit with claims unless requested.